Chen Ying, Cai Xiaoyan, Huang Weijun, Wu Yanxian, Huang Yuli, Hu Yunzhao
From the Department of Cardiology (YC, WH, YW, YH, YH); The Second Out-patient Department, the First People's Hospital of Shunde (YC); and Clinical Medicine Research Institute, the First People's Hospital of Shunde, Foshan, P.R. China (XC, YH, YH).
Medicine (Baltimore). 2015 Dec;94(52):e2409. doi: 10.1097/MD.0000000000002409.
Digoxin is still commonly used in atrial fibrillation (AF) patients with and without heart failure (HF) for heart rate control. Studies concerning the detrimental effects of digoxin therapy in AF patients are inconsistent. This updated meta-analysis examined the association of digoxin therapy with all-cause mortality in AF patients, stratified by heart function status. We included observational studies with multivariate-adjusted data on digoxin and all-cause mortality in the analysis. The relative risks (RRs) of all-cause mortality were calculated and reported with 95% confidence intervals (95% CIs). Seventeen studies comprising 408,660 patients were included. Overall, in AF patients, digoxin treatment was associated with a significant increase in all-cause mortality after multivariate-adjustment (RR = 1.22; 95% CI 1.15-1.30). When stratified by heart function status, digoxin treatment was associated with a 14% increase in all-cause mortality in AF patients with HF (RR = 1.14, 95% CI 1.04-1.24), and a 36% increase in those without HF (RR = 1.36, 95% CI 1.18-1.56). The increased risk of all-cause mortality was significantly higher in AF patients without HF compared with those with HF (P for interaction = 0.04). This meta-analysis demonstrates that digoxin therapy was associated with a significant increase in all-cause mortality in AF patients, especially in those without HF. Given other available options, digoxin should be avoided as a first-line agent for heart rate control in AF patients.
地高辛仍常用于伴有或不伴有心力衰竭（HF）的心房颤动（AF）患者以控制心率。关于地高辛治疗对AF患者有害影响的研究结果并不一致。这项更新的荟萃分析探讨了地高辛治疗与AF患者全因死亡率之间的关联，并按心功能状态进行分层。我们纳入了分析中具有地高辛和全因死亡率多变量调整数据的观察性研究。计算并报告全因死亡率的相对风险（RRs）及其95%置信区间（95% CIs）。纳入了17项研究，共408,660例患者。总体而言，在AF患者中，多变量调整后地高辛治疗与全因死亡率显著增加相关（RR = 1.22；95% CI 1.15 - 1.30）。按心功能状态分层时，地高辛治疗使伴有HF的AF患者全因死亡率增加14%（RR = 1.14，95% CI 1.04 - 1.24），使不伴有HF的患者全因死亡率增加36%（RR = 1.36，95% CI 1.18 - 1.56）。与伴有HF的AF患者相比，不伴有HF的AF患者全因死亡率增加风险显著更高（交互作用P值 = 0.04）。这项荟萃分析表明，地高辛治疗与AF患者全因死亡率显著增加相关，尤其是在不伴有HF的患者中。鉴于有其他可用选择，应避免将地高辛作为AF患者心率控制的一线药物。
